ABSTRACT Background Oral carcinoma cuniculatum (OCC) is a rare, well‐differentiated variant of oral squamous cell carcinoma (SCC) that often mimics benign lesions, resulting in delayed diagnosis. Evidence on its clinical behavior and risk of recurrence remains limited. Methods We report a representative OCC case and conducted a PRISMA‐based systematic review of PubMed, Embase, Cochrane Library, Google Scholar, and Airiti Library, including studies with patient‐level data. Results Forty‐six studies comprising 115 patients were included. The gingiva was the most common primary site. Nodal metastasis was reported in 9.0% (8/89), and the overall recurrence rate was 15.8%, predominantly local. Higher recurrences were found among patients receiving neck dissection or adjuvant therapy, which likely reflected selection bias rather than a treatment effect. Conclusions OCC shows a low nodal metastatic rate and mainly local recurrence. Routine elective neck dissection may not be required in clinically N0 patients, but this hypothesis requires validation in larger, multi‐institutional cohorts.
Huang et al. (Tue,) studied this question.